Sitting Posture Decreases Collapsibility of the Passive Pharynx in Anesthetized Paralyzed Patients with Obstructive Sleep Apnea

Tagaito, Yugo; Isono, Shiroh; Tanaka, Atsuko; Ishikawa, Teruhiko; Nishino, Takashi

doi:10.1097/aln.0b013e3181f1b834

Cited by 66 publications

(49 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Depending on method used for assessment and population studied, symptoms of sleep apnea occurred in up to 85% in a cohort of women with preeclampsia. [1][2][3] During the postpartum period, airway obstructions are a main cause of anesthesia related maternal death in North America, 4 and increased vulnerability to airway obstruction may be successfully treated with adequate body position, as elevated posture has been shown to improve UA size accessed by acoustic pharyngometry 5 and collapsibility during anesthesia 6 and sleep, as well as during wakefulness in pregnant women. 7,8 Nevertheless, the effect of elevated upper body position on airway size and pregnancy associated OSA is currently unknown.…”

Section: A S E R E P O R T Smentioning

confidence: 99%

Elevated Body Position Early after Delivery Increased Airway Size during Wakefulness, and Decreased Apnea Hypopnea Index in a Woman with Pregnancy Related Sleep Apnea

Jung

Zaremba

Heisig

et al. 2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Section: A S E R E P O R T Smentioning

confidence: 99%

Elevated Body Position Early after Delivery Increased Airway Size during Wakefulness, and Decreased Apnea Hypopnea Index in a Woman with Pregnancy Related Sleep Apnea

Jung

Zaremba

Heisig

et al. 2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

“…A sitting position improves collapsibility of the pharyngeal airway in anaesthetised and paralysed patients with obstructive sleep apnoea [9]. A recent study indicated that the vocal cord view is improved in the 25°semi-sitting position with direct laryngoscopy [10].…”

Section: Introductionmentioning

confidence: 99%

Effects of the jaw‐thrust manoeuvre in the semi‐sitting position on securing a clear airway during fibreoptic intubation

et al. 2015

View full text Add to dashboard Cite

SummarySecuring a clear airway is important for successful fibreoptic intubation. We investigated whether the jaw-thrust manoeuvre in the 25°semi-sitting position improves airway clearance compared with the supine position in 88 anaesthetised patients randomly assigned to the two positions. After induction of anaesthesia, the fibreoptic bronchoscope was advanced into the mouth along the dorsum of the tongue during the jaw-thrust manoeuvre. Airway clearance was assessed at the level of the soft palate and epiglottis. Patients in the 25°semi-sitting position had clearer airways (judged subjectively by a three-level scale) than those in the supine position at the soft palate level (p = 0.012). At the level of the epiglottis, airway clearance was equally good in both positions. The mean (SD) times to view the vocal cord and carina were shorter in the 25°semi-sitting position (4 (1) s and 8 (1) s, respectively) compared with the supine position (6 (3) s and 11 (3) s; p < 0.001, respectively). The time to achieve intubation was also shorter in the 25°semi-sitting position (21 (5) s) than in the supine position (25 (7) s; p = 0.018).

show abstract

“…During wakefulness, patients with OSA compensate for diminished airway anatomical features by increasing the cranio-cervical angulation that lifts the hyo-mandibular complex (tongue, soft tissues and mandible) away from the spine, thereby increasing the airway space [11]. This useful compensation is lost during anesthesia since most anesthetics diminish critical UA muscular tone, thereby promoting airway collapse [12][13][14][15][16].…”

Section: Difficult Airwaymentioning

confidence: 99%

“…The first is to bring the patient into a seated position (if not already there). For example, under propofol/ vecuronium anesthesia, moving the patient from the supine to the sitting position improved (enlarged) both retropalatal and retroglossal regions in anesthetized and paralyzed patients with OSA, indicating that the structural properties of the passive pharynx were improved [12]. Second, and perhaps a bit easier to implement, is to extend the neck, enhancing the "sniffing" position for improved pharyngeal airway patency in OSA patients [27].…”

Section: Optimizing the Anesthetic Induction Periodmentioning

confidence: 99%

Morbid Obesity and Obstructive Sleep Apnea: The Challenging Link

Ebert¹

2011

TOATJ

View full text Add to dashboard Cite

Abstract:Obstructive sleep apnea (OSA) is a common medical condition that is increasing in prevalence and is associated with substantial morbidity and a 40% eight-year mortality rate if left untreated. Morbidly obese patients have a greater incidence of co-morbid disease, including OSA. OSA is characterized by repeated upper airway obstruction and arousal during sleep, sympathetic activation, hypertension and daytime somnolence. In morbidly obese OSA patients undergoing surgical procedures, the perioperative period is more challenging than in non obese OSA patients. Their airway anatomy is often abnormal with excess pharyngeal tissue and tongue size making it difficult to ventilate thru a facemask and to establish tracheal intubation. Several suggestions for optimizing the anesthetic induction, emergence, and early recovery periods in these patients are offered. Most important are positioning of the patient (both during and post surgery), pre-oxygenation prior to intubation, proper dosing of anesthetic maintenance drugs to ideal body weight, alveolar recruitment maneuvers, full reversal of paralysis at the end of surgery, and careful drug titration in recovery to improve pulmonary mechanics. With proper preparation and precautions it is possible to avoid the significant high frequency of respiratory and cardiac complications observed in these patients and to avoid or better manage length of hospital stay, unplanned ICU admission and/or reintubation.

show abstract

Sitting Posture Decreases Collapsibility of the Passive Pharynx in Anesthetized Paralyzed Patients with Obstructive Sleep Apnea

Abstract: Postural change from supine to sitting significantly improves collapsibility of pharyngeal airway in anesthetized and paralyzed patients with OSA.

Cited by 66 publications

References 30 publications

Elevated Body Position Early after Delivery Increased Airway Size during Wakefulness, and Decreased Apnea Hypopnea Index in a Woman with Pregnancy Related Sleep Apnea

Elevated Body Position Early after Delivery Increased Airway Size during Wakefulness, and Decreased Apnea Hypopnea Index in a Woman with Pregnancy Related Sleep Apnea

Effects of the jaw‐thrust manoeuvre in the semi‐sitting position on securing a clear airway during fibreoptic intubation

Morbid Obesity and Obstructive Sleep Apnea: The Challenging Link

Contact Info

Product

Resources

About